Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Fracture of Metatarsal Bones

SYMPTOMS

There is a sharp localised exerciseinduced pain over a metatarsal bone. Most commonly, MT IV or V are affected, often after a previous sprain or after a direct impact injury.

AETIOLOGY

The injury is either caused by direct impact, for example from football boot studs, or by excessive repetitive stress from forefoot running or jumping, sometimes due to faulty shoes or inlays with the breaking point of the sole over the mid-part of a metatarsal.

CLINICAL FINDINGS

There is swelling and distinct tenderness on palpation over the fractured metatarsal bone.

INVESTIGATIONS

X-ray can be mistaken for normal if the stress fracture is undisplaced until there is callus formation, which occurs within a few weeks. MRI shows localised bone oedema very early. CT scans can disclose the fracture line. Displaced fractures, which are rare, are diagnosed directly by X-ray.

TREATMENT

This depends on the location of the fracture. While MT IV fractures usually heal with the use of non-weight-bearing boots and modifications in training within four to eight weeks, MT V fractures can be hazardous if displaced or unstable, leading to non-union and long-term problems, independent of treatment. Immobilisation in a nonweight-bearing boot or surgery may be indicated. Stress fractures to the first and second metatarsal bones are more uncommon in athletes.

REFERRALS

Refer to orthopaedic surgeon for consideration of immobilisation or surgery with screw fixation.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of non-impact sporting activities using well-fitting shoes, non-weight-bearing boots or strapping and avoiding impact. Suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs and X-ray showing healed fracture.

PROGNOSIS

Excellent-Good in most cases but may be career-threatening for professional players, due to long healing times.

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